Basic Information
Provider Information
NPI: 1063463057
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLEWILER
FirstName: HORACE
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1605 N CEDAR CREST BLVD
Address2: SUITE 110B
City: ALLENTOWN
State: PA
PostalCode: 181042351
CountryCode: US
TelephoneNumber: 6109731410
FaxNumber: 6109731449
Practice Location
Address1: 1 E ELIZABETH AVE
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180186522
CountryCode: US
TelephoneNumber: 6108654131
FaxNumber: 4844034009
Other Information
ProviderEnumerationDate: 05/13/2006
LastUpdateDate: 08/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD007710EPAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
0105570501PACAPITAL BLUE CROSSOTHER
01860701PAHIGHMARK PA BLUE SHIELDOTHER
000592369000105PA MEDICAID
11011826401PAPALMETTO GBA MEDICAREOTHER


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